Early Look At ACA Repeal Brings Early Questions
The GOP proposal to repeal and replace the Affordable Care Act is on the table.
The GOP Plan offers tax credits instead of individual subsidies for coverage. The credit starts going away as incomes rise.An Illinois Wesleyan University Political Scientist said the early look at the Republican proposal is not encouraging.
Greg Shaw has written extensively on health care policy and his latest book, "The Dysfunctional Politics of the Affordable Care Act," is coming out in May.
Shaw said it's not clear that health insurance coverage will be more affordable or that enrollments will be higher under the GOP plan than under Obamacare.
Under the ACA some people were still being priced out of the market, particularly if they were in the middle income brackets, or they were forced to buy policies that were of little use because of coverage limits and high deductibles. The GOP tax credits would go to more people, but provide less support than the ACA subsidies.
Shaw said the GOP plan hits different categories of people harder because the tax credits under the bill are lower than the subsidies for ACA supported policies.
"Younger people who can barely afford these premiums if they indeed feel a need to get covered. Low income people will probably suffer disproportionately under this," said Shaw.
Older Americans, Shaw said, may also find the proposal difficult.
"If the House Republicans have their way, insurers will be able to charge them five times as much as young people, compared to three times as much under the Affordable Care Act," said Shaw,
Instead of the tax penalty for failing to buy insurance, the GOP plan has a 30% surcharge for letting coverage lapse more than two months. Shaw said this could have several effects including encouraging healthy people to stay out of the insurance market.
"Or it's a disincentive also to move out of a job that you perceive as dead end. And so, it could very well dampen the fluidity of the labor market. And that's obviously not a good thing," said Shaw.
The GOP proposal to replace the Affordable Care Act would give block grants to states for Medicaid, dramatically changing that entitlement. IWU political scientist Greg Shaw agrees with Democrats it would be a slow poison to the Medicaid program.
"I don't think Medicaid works as a block grant program. The costs are so huge. The needs are literally life and death," said Shaw.
The Medicaid expansion was one of the key pieces of the Affordable Care Act, adding insurance coverage for more than 11 million people nationwide. Shaw said it's possible the block grants would eventually starve the states into limiting enrollment or cutting reimbursement rates for services below the point most medical providers would agree to participate.
"You know, medical services, there's a certain pay me now or pay me later quality to this. You can either fund this up front and see that people get appropriate care in appropriate venues or you can pay emergency department bills later on," said Shaw.
Shaw also said it's unclear whether Congress will have the appetite to try to tackle cost increases in the prescription drug sector. He says that drives about ten percent of the overall price of healthcare.
Shaw cautioned the bill is in its very early stages and a lot of changes will, no doubt, come along to address current doubts about the plan.
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